产甲胎蛋白胃癌的临床病理及预后分析

摘要

目的 分析产甲胎蛋白胃癌的临床病理学特征及预后影响因素,为临床诊断及治疗提供依据.方法 回顾分析1999年1月到2007年1月在广西医科大学附属第五医院住院的507例胃癌患者的病历资料,其中产甲胎蛋白胃癌(AFPGC)29例.详细记录AFPGC的临床病理及随访资料.采用SPSS 18.0统计软件包分析AFPGC的临床病理特征及影响预后的因素.结果 AFPGC占同期胃癌的5.7%,与普通胃癌相比,AFPGC具有较高的淋巴转移率、肝转移率,差异具有统计学意义(均P＜0.05).术前AFP水平偏高,肿瘤组织免疫组织化学检测显示原发病灶AFP染色强阳性,术后AFP有不同程度的降低或降至正常.生存分析发现产AFP胃癌患者的5年生存率低于普通胃癌,差异有统计学意义(P＜0.05),单因素分析发现影响其预后的因素有肝转移、淋巴转移、TNM分期及分化程度.结论 产AFP胃癌具有易发生肝转移、淋巴转移且预后差的特点,早诊断、早治疗是目前提高治愈率和患者生存率的重要措施.%Objective To analyze the clinicopathological features and prognostic factors of alpha-fetoprotein-producing gastric carcinoma (A FPGC). Methods From January 1999 to January 2007 ,507 cases of gastric cancer including 29 cases of AF-PGC were admitted to the Fifth Affiliated Hospital of Guangxi Medical University ,all the medical records were reviewed and data on clinicopathological characteristic and follow-up were collected. The clinicopathological characteristics and prognostic factors were evaluated by Chi-square test. The survival rate was calculated by Kaplan-Meier method. Significance level was set at 0. 05. Statistical analyses were conducted using SPSS 18. 0 Statistical Package. Results The prevalence rate of AFPGC accounted for 5. 7% of the gastric cancer at the corresponding period. Compared with non-AFPGC ,AFPGC had higher rate of lymph node and liver metastasis (P<0. 05). The level of preoperative serum AFP was normal ,and immunohistochemistry showed that the AFP staining was strong positive at primary lesions. After operation ,the serum level of AFP was reduced. Survival analysis showed that 5-year survival rate of AFPGC was significantly lower than that of the non-AFPGC (P<0. 05). Univariate analysis revealed the prognostic factors included liver metastasis , lymph node metastasis , TNM stage, and grade of differentiation. Conclusion AFPGC is prone to proceed liver metastases ,lymph node metastases and the prognosis is very poor. Early diagnosis and early treatment are important measures to improve the curative rate and survival rate of the patients .